Are Invasive Procedures and a Longer Hospital Stay Increasing the Risk of Healthcare-Associated Infections among the Admitted Patients at Hiwot Fana Specialized University Hospital, Eastern Ethiopia?

Characteristic Features and Outcomes of Open Gunshot Fractures of Long-bones with Gustilo Grade 3: A Retrospective Study

BACKGROUND

The incidence of gunshot injuries is growing, and civilian orthopedics should be more aware of the treatment and consequences of these injuries. This study aimed to describe the characteristic features and complications of gunshot injuries to long-bones.

METHODS

A total of 50 patients who presented with an open gunshot fracture of the tibia, humerus, and femur in the emergency room of our hospital were included in this study. Primary irrigation and debridement, as well as prophylactic antibiotics, were administered in the emergency room. The treatment was performed either conservatively (n=4) or surgically (n=46). The external fixator, nailing, or plating was used for surgical fixation.

RESULTS

The mean age and follow-up duration of the patients were 32.3±9.9 years and 13.1±5.6 months, respectively. The most common injured long bone was the femur (32 of 50). Regarding the Gustilo grade, IIIa, IIIb, and IIIc were observed in 37, 7, and 5 patients, respectively. The Masquelet technique was used for 7 (14%) patients, and 12 (24%) cases had skin flaps. Furthermore, the vascular injury was present in 5 (10%) patients, and Malunion of the fracture site was observed in 5 (10%) cases. Nonunion of the fractured bone occurred in 13 (26%) patients that was significantly associated with the presence of vascular injuries (P=0.02). Postoperative infection occurred in 9 (18%) patients and was significantly associated with the presence of skin flap (P=0.014).

CONCLUSION

Gunshot injuries of long bones are associated with a high incidence of post-treatment complications, such as infection and nonunion, and therefore, more intensive care should be taken to avoid these complications.

The Standardization of Hospital-Acquired Infection Rates Using Prediction Models in Iran: Observational Study of National Nosocomial Infection Registry Data

Background

Many factors contribute to the spreading of hospital-acquired infections (HAIs).

Objective

This study aimed to standardize the HAI rate using prediction models in Iran based on the National Healthcare Safety Network (NHSN) method.

Methods

In this study, the Iranian nosocomial infections surveillance system (INIS) was used to gather data on patients with HAIs (126,314 infections). In addition, the hospital statistics and information system (AVAB) was used to collect data on hospital characteristics. First, well-performing hospitals, including 357 hospitals from all over the country, were selected. Data were randomly split into training (70%) and testing (30%) sets. Finally, the standardized infection ratio (SIR) and the corrected SIR were calculated for the HAIs.

Results

The mean age of the 100,110 patients with an HAI was 40.02 (SD 23.56) years. The corrected SIRs based on the observed and predicted infections for respiratory tract infections (RTIs), urinary tract infections (UTIs), surgical site infections (SSIs), and bloodstream infections (BSIs) were 0.03 (95% CI 0-0.09), 1.02 (95% CI 0.95-1.09), 0.93 (95% CI 0.85-1.007), and 0.91 (95% CI 0.54-1.28), respectively. Moreover, the corrected SIRs for RTIs in the infectious disease, burn, obstetrics and gynecology, and internal medicine wards; UTIs in the burn, infectious disease, internal medicine, and intensive care unit wards; SSIs in the burn and infectious disease wards; and BSIs in most wards were >1, indicating that more HAIs were observed than expected.

Conclusions

The results of this study can help to promote preventive measures based on scientific evidence. They can also lead to the continuous improvement of the monitoring system by collecting and systematically analyzing data on HAIs and encourage the hospitals to better control their infection rates by establishing a benchmarking system.

Healthcare-associated infections and antimicrobial use in surgical wards of a large urban central hospital in Blantyre, Malawi: a point prevalence survey

Background

There are limited data on healthcare-associated infections (HAI) from African countries like Malawi.

Aim

We undertook a point prevalence survey of HAI and antimicrobial use in the surgery department of Queen Elizabeth Central Hospital (QECH) in Malawi and ascertained the associated risk factors for HAI.

Methods

A cross-sectional point prevalence survey (PPS) was carried out in the surgery department of QECH. The European Centre for Disease Prevention and Control PPS protocol version 5.3 was adapted to our setting and used as a data collection tool.

Findings

105 patients were included in the analysis; median age was 34 (IQR: 24-47) years and 55.2% patients were male. Point prevalence of HAI was 11.4% (n=12/105) (95% CI: 6.0%-19.1%), including four surgical site infections, four urinary tract infections, three bloodstream infections and one bone/joint infection. We identified the following risk factors for HAI; length-of-stay between 8 and 14 days (OR=14.4, 95% CI: 1.65-124.7, p=0.0143), presence of indwelling urinary catheter (OR=8.3, 95% CI: 2.24-30.70, p=0.003) and history of surgery in the past 30 days (OR=5.11, 95% CI: 1.46-17.83, p=0.011). 29/105 patients (27.6%) were prescribed antimicrobials, most commonly the 3rd-generation cephalosporin, ceftriaxone (n=15).

Conclusion

The prevalence rates of HAI and antimicrobial use in surgery wards at QECH are relatively high. Hospital infection prevention and control measures need to be strengthened to reduce the burden of HAI at QECH.

Antibiotic-Resistant Profiles of Bacteria Isolated from Cesarean and Surgical Patients from Kasese District Hospitals Western Uganda

Surgical site infections (SSIs) are challenging to treat and often associated with much higher extended stays, morbidity, and mortality, higher treatment costs, especially when the causative agent is multidrug resistance (MDR). This study was designed to determine the prevalence of nosocomial infections and susceptibility profiles of bacteria isolated from Cesarean section (C-section) and surgical patients from Kasese District Hospitals in Western Uganda. A descriptive cross-sectional study was conducted from January to September 2016 involving 303 patients with SSIs in obstetrics & gynecology; and general surgery wards in three health facilities. Clinical-demographic characteristics of patients were obtained using structured questionnaires before surgery. Bacterial analysis of the air and floor of the theatre room was done using the standard culture method. Of the 303 patients enrolled with SSIs (median age 34 years), 71.6% were female, and 28.4% were males. Only 14.5% developed SSIs, with predominant isolates being Staphylococcus aureus 33.33% and Escherichia coli 24%. The majority of recruited participants underwent a C-section of 58% and the least amputations of 0.3%. Duration of operation or surgery, p-value 0.002 (95% CI 1.599-7.667) was significantly associated with SSIs. Gram-negative bacteria were found resistant (50-100%) to ampicillin, gentamycin, and ciprofloxacin, the commonly used post-operative drugs of choice. Hospital-acquired infections were common with emerging antibiotic-resistant strains isolated in most SSIs at Kasese hospitals. The development of resistance to commonly used antibiotics such as ampicillin, gentamycin, and ciprofloxacin than previously reported calls for laboratory-guided SSIs therapy and strengthening infection control policies.

Prevalence of hospital-acquired infections (HAIs) and associated factors in Ethiopia: a systematic review and meta-analysis protocol

INTRODUCTION

Hospital-acquired infections (HAIs) are public health problems of global concern and are notably prevalent in developing countries. The prevalence of HAI and its associated factors are not well described in the context of Ethiopia. Currently, the nationwide prevalence of HAI and its corresponding associated factors have not been formally reported in Ethiopia. This review will provide an estimate of the prevalence of HAI and its associated factors.

METHODS

Scholarly articles will be selected from the Embase, PubMed, Cochrane library, Hinary, Scopus, Web of Science and Google Scholar databases. Articles within the timeline of January 2000 to December 2020 will be included for review. Observational studies, randomised trials, surveys, surveillance reports, published and grey literature that reported the prevalence of HAI or factors associated with HAI reported as OR (95% CI) with no language restriction will be included in the analysis. Screening and selection of articles will be done using web-based Covidence software. The article's quality and risk of bias will be critically appraised using Johanna Briggs Institute quality appraisal checklist. Random effects model using the inverse variance method will be conducted to estimate the prevalence of HAI. To examine heterogeneity, the Q statistics and I2 statistics will be conducted. Publication bias will be investigated using Begg's correlation method and Egger's weighted regression test. All analyses will be performed with STATA (V.14) software.

ETHICS AND DISSEMINATION

Ethical approval is not required for meta-analysis reviews as participants are not included. The review will be submitted for publication in peer-reviewed journals.